Printable Forms: Great West Life Selectpac
Forms for group plans with 3 to 35 members
Application for Group Coverage
- A new member must complete this form upon becoming eligible to participate in their group insurance plan.
- This form is used to update information about plan members and/or their dependents.
- This form is used to designate a trustee for a beneficiary who is a minor or who is legally unable to manage their own affairs.
- This form is used to collect the information needed to apply for group benefits which require medical underwriting, such as Optional Life, Excess Life, and LTD, Supplemental Life and Late applicants.
This form is used to submit information about a plan member who is returning to work after a short-term or long-term disability absence.
Forms for group plans with more than 35 members:
Application for Group Coverage
- A new member must complete this form upon becoming eligible to participate in their group insurance plan.
- This form is used to update information about plan members and/or their dependents.
- This form is used to designate a trustee for a beneficiary who is a minor or who is legally unable to manage their own affairs.
- This form is used to collect the information needed to apply for group benefits which require medical underwriting, such as Optional Life, Excess Life, Supplemental Life and Late applicants.
Group Life Conversion Privilege Notification form
- This form is used to provide information necessary for converting group life insurance plan members to a conversion individual life insurance policy.
- This form is used to submit information about a plan member who is returning to work after a short-term or long-term disability absence.
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